Quality Metrics Toolkit

2022 Metrics Medicaid Toolkit 

• Adolescent immunizations
• Alcohol and drug misuse (SBIRT)
• Assessments for children in DHS custody
• Child and adolescent well-care visits (WCV)
• Childhood immunization status
• Cigarette smoking prevalence
• Depression screening and follow-up plan
• Diabetes: HbA1c poor control
• Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
• Meaningful Access to Health Care Services for persons with limited English proficiency
• Oral evaluation for adults with diabetes
• Preventive dental or oral services - Ages 1-5 & 6-14
• Social-emotional health metric
• Timeliness of prenatal and postpartum care

2021 Metrics Toolkit 

• Adolescent immunizations
• Alcohol and drug misuse (SBIRT)
• Assessments for children in DHS custody
• Breast cancer screening
• Care for older adults: Functional status assessment
• Care for older adults: Medication review
• Care for older adults: Pain screening
• Childhood immunization status
• Cigarette smoking prevalence
• Colorectal cancer screening
• Controlling high blood pressure
• Depression screening and follow-up plan
• Diabetes: Eye exam
• Diabetes: HbA1c poor control
• Diabetes care: Nephropathy monitoring
• Disparity measure: Emergency department utilization for individuals experiencing mental illness
• HOS: Improving bladder control
• HOS: Monitoring physical activity
• HOS: Reduce the risk of falling
• Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
• Inpatient and emergency department utilization for ambulatory care sensitive conditions
• Meaningful Access to Health Care Services for persons with limited English proficiency
• Medication adherence for cholesterol statins
• Medication adherence for diabetes medications
• Medication adherence for hypertension
• Oral evaluation for adults with diabetes
• Osteoporosis
• Statin therapy for patients with cardiovascular disease
• Timeliness of prenatal and postpartum care

More resources

• 2022 Medicaid Metrics toolkit
• 2021 CareOregon Quality Metrics Toolkit
• 2022-23 CareOregon PCPM Program Description 
• OHA Metrics: oregon.gov/oha/HPA/ANALYTICS/Pages/CCO-Metrics.aspx
• OHA Transformation Center: oregon.gov/oha/hpa/csi-tc/pages/index.aspx
• Medicare Star Ratings Technical Specs: cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData
• HEDIS Measures: ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2018
• CMS: cms.gov/
• Value sets can be accessed through the Value Set Authority Center (VSAC) at the National Library of Medicine: vsac.nlm.nih.gov. Value sets include CPT, HCPC, ICD-9, ICD-10, SNOMED, and RXNORM codes
• Quality Improvement: ihi.org/resources/Pages/default.aspx
• Certified Health IT Product List is a resource for determining EMR reporting capacity: chpl.healthit.gov/#/search
• STOP CRC implementation guide
• IET Billing guide
• Words matter
• Recovery oriented language guide
• Diabetes and oral health: Improve patient outcomes
• Primary care integration holds untold possibilities when we look at the ways member subpopulations could benefit from greater collaboration among their physical, dental and behavioral health providers. In 2019, Health Share of Oregon tasked CareOregon to create the Diabetes Integration Project, a long-term project for members diagnosed with both type II diabetes and severe and persistent mental illness. Here’s a summary of those efforts, led by the CareOregon Innovation Team, and ways these principles can be applied to other provider groups:
  Diabetes Integration Project 2019-2021.